Behavioral Treatment of Nonadherence in Pediatric Inflammatory Bowel Disease

描述(由申请人提供)：在慢性病治疗中，不遵守医疗方案是一个普遍而重要的问题，影响患者的健康和生活质量、临床决策和医疗费用。大约50%的儿童和65%到75%的青少年慢性病患者是不遵守规定的。研究一直表明，患者和家庭行为因素导致儿童和青少年的依从性较差。然而，目前还没有针对青少年不依从性的标准化治疗方案。针对患者和家庭因素的多成分行为治疗显示，幼儿对药物的依从性有了显著改善；然而，需要研究开发针对青少年不依从性的行为干预措施，特别是那些患有炎症性肠病(IBD)的青少年，因为他们是一个研究不足的人群，不依从率高达62%。这一应用的长期目标是为继续开发有效的治疗不粘连的方法提供基础，特别是在儿童IBD中。拟议研究计划的具体目的是设计一种针对药物不依从性的行为组治疗，并通过随机对照临床试验来测试这种治疗方法在青少年IBD患者中的疗效。干预将使用多方法评估方法，并整合定量和定性数据，以针对教育、组织和行为因素。我们将检验这样的假设，即干预将是可行和可接受的，与通常护理控制条件下的患者相比，治疗条件下的患者将在服药依从性、疾病功能和生活质量方面表现出改善。这项申请将通过职业发展计划推动儿科心理学家Kevin Hommel博士作为一名独立研究员的发展，该计划包括1)重点指导与高级研究人员的合作，2)治疗结果研究、药理学、数据分析、健康经济学和生物伦理学的教学培训，3)临床和研究培训研讨会，以及4)专业发展活动。相关性：这项研究的结果将有助于公共健康，为青少年药物违规行为治疗的持续发展提供基础。这些循证干预措施应最终提高卫生保健的有效性和患者的生活质量。

DESCRIPTION (provided by applicant): Nonadherence to medical regimens is a pervasive and significant problem in chronic illness treatment affecting patient health and quality of life, clinical decisions, and health care costs. Approximately 50 percent of children and 65 to 75 percent of adolescent chronic illness patients are nonadherent. Studies have consistently shown that patient and family behavioral factors contribute to poorer adherence in children and adolescents. However, no standardized treatment protocol for nonadherence in adolescents exists. Multicomponent behavioral treatments that target patient and family factors have demonstrated significant improvements in adherence to medication in young children; however, research is needed to develop behavioral interventions targeting nonadherence in adolescents, particularly those with inflammatory bowel disease (IBD), as they are an understudied population with nonadherence rates as high as 62 percent. The long-term objective of this application is to provide a basis for continued development of effective treatments for nonadherence, particularly in pediatric IBD. The specific aim of the proposed research plan is to design a behavioral group treatment targeting medication nonadherence, and test the efficacy of this treatment in adolescents with IBD via a randomized controlled clinical trial. The intervention will use a multimethod assessment approach and integrate quantitative and qualitative data to target educational, organizational, and behavioral factors. We will test the hypotheses that the intervention will be feasible and acceptable, and that patients in the treatment condition will demonstrate improvement in medication adherence, disease functioning, and quality of life compared to patients in a usual care control condition. This application will advance the development of Dr. Kevin Hommel, a pediatric psychologist, as an independent investigator through a career development plan that includes 1) focused mentorship and collaboration with senior investigators, 2) didactic training in treatment outcome research, pharmacology, data analysis, health economics, and bioethics, 3) clinical and research training seminars, and 4) professional development activities. Relevance: Results of this research will contribute to public health by providing a basis for continued development of behavioral treatments for adolescent medical nonadherence. These evidence-based interventions should ultimately improve the effectiveness of health care and patient quality of life.